Yu Junjian, Zheng Taohua, Yuan Antai, Wang Wei, Li Zequn, Cao Shougen
Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Liver Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
J Surg Res. 2025 Feb;306:257-265. doi: 10.1016/j.jss.2024.11.008. Epub 2025 Jan 13.
Patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia (PCEA) constitute two major advances in pain management after major abdominal surgery. However, the role of PCIA or PCEA has not been particularly studied in elderly patients with gastric cancer. The aim of this study is to make a comparison between PCIA and PCEA in terms of their performance on short-term outcomes in elderly patients undergoing laparoscopic-assisted gastrectomy.
This single-center, retrospective study included 254 elderly patients (≥70 y) who underwent laparoscopic radical gastrectomy for gastric cancer. Patients received either general anesthesia combined with epidural anesthesia followed by PCEA (PCEA group, n = 123) or general anesthesia alone followed by PCIA (PCIA group, n = 131). The primary endpoint was pain intensity-tested using a 100-mm visual analog scale on postoperative days 1, 2, and 3. Demographics, comorbidities, perioperative data, postoperative short-term outcomes, and analgesia-related side effects were also assessed.
The visual analog scale scores at rest were lower in the PCEA group compared to the PCIA group on postoperative day 1, 2, and 3 (27.8 ± 13.9 versus 33.1 ± 15.0, P = 0.004; 25.2 ± 11.3 versus 30.1 ± 14.3, P = 0.002; 16.9 ± 7.1 versus 20.9 ± 9.5, P < 0.001, respectively). The postoperative hospital stay was shorter in the PCEA group than in the PCIA group (11 versus 12 d, P = 0.018). The times to postoperative first flatus, semifluid diet, independent ambulation, and tracheal extubation after surgery in the PCEA group were significantly shorter than in the PCIA group. Overall morbidity, mortality, hospital readmission rate, and reoperation rate were not significantly different between the two groups. Regarding side-effects related to analgesia, there were no significant differences in terms of the rates of postoperative nausea and vomiting, urinary retention, or oxygen saturation <90% between the two groups. However, PCEA was associated with a higher incidence of postoperative hypotension compared to PCIA (10.6% versus 3.8%, P = 0.036).
In elderly patients undergoing laparoscopic radical gastrectomy, epidural anesthesia and analgesia may convey superior pain relief, faster restoration of gastrointestinal motility, and shorter hospitalization.
患者自控静脉镇痛（PCIA）和患者自控硬膜外镇痛（PCEA）是腹部大手术后疼痛管理的两大主要进展。然而，PCIA或PCEA在老年胃癌患者中的作用尚未得到特别研究。本研究的目的是比较PCIA和PCEA在老年腹腔镜辅助胃切除术患者短期预后方面的表现。
本单中心回顾性研究纳入了254例接受腹腔镜根治性胃癌切除术的老年患者（≥70岁）。患者接受全身麻醉联合硬膜外麻醉后行PCEA（PCEA组，n = 123）或单纯全身麻醉后行PCIA（PCIA组，n = 131）。主要终点是在术后第1、2和3天使用100毫米视觉模拟量表测试的疼痛强度。还评估了人口统计学、合并症、围手术期数据、术后短期预后和镇痛相关副作用。
PCEA组术后第1、2和3天静息时的视觉模拟量表评分低于PCIA组（分别为27.8±13.9对33.1±15.0，P = 0.004；25.2±11.3对30.1±14.3，P = 0.002；16.9±7.1对20.9±9.5，P < 0.001）。PCEA组的术后住院时间比PCIA组短（11天对12天，P = 0.018）。PCEA组术后首次排气、半流质饮食、独立行走和术后气管拔管的时间明显短于PCIA组。两组的总体发病率、死亡率、住院再入院率和再次手术率无显著差异。关于镇痛相关副作用，两组术后恶心呕吐、尿潴留或氧饱和度<90%的发生率无显著差异。然而，与PCIA相比，PCEA术后低血压的发生率更高（10.6%对3.8%，P = 0.036）。
在接受腹腔镜根治性胃切除术的老年患者中，硬膜外麻醉和镇痛可能带来更好的疼痛缓解、更快的胃肠动力恢复和更短的住院时间。
